Intended for healthcare professionals


Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study

BMJ 2006; 332 doi: (Published 23 March 2006) Cite this as: BMJ 2006;332:692
  1. Murna Downs, professor in dementia studies (m.downs{at},
  2. Stephen Turner, senior researcher2,
  3. Michelle Bryans, D Clin Psych student3,
  4. Jane Wilcock, research fellow4,
  5. John Keady, professor of admiral nursing5,
  6. Enid Levin, practice development manager6,
  7. Ronan O'Carroll, professor of psychology7,
  8. Kate Howie, statistical consultant and teaching fellow8,
  9. Steve Iliffe, reader in general practice4
  1. 1 Bradford Dementia Group, Division of Dementia Studies, School of Health Studies, University of Bradford, Bradford BD5 0BB
  2. 2 Dental Health Services Research Unit, University of Dundee, Dundee
  3. 3 Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh
  4. 4 Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London
  5. 5 School of Health Education and Community Studies, Northumbria University, Benton, Newcastle upon Tyne
  6. 6 Social Care Institute for Excellence, London
  7. 7 Department of Psychology, University of Stirling, Stirling
  8. 8 Department of Computing, Science, and Mathematics, University of Stirling
  1. Correspondence to: M Downs
  • Accepted 23 February 2006


Objective To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care.

Design Unblinded, cluster randomised, before and after controlled study.

Setting General practices in the United Kingdom (central Scotland and London) between 1999 and 2002.

Interventions Three educational interventions: an electronic tutorial carried on a CD Rom; decision support software built into the electronic medical record; and practice based workshops.

Participants 36 practices participated in the study. Eight practices were randomly assigned to the electronic tutorial; eight to decision support software; 10 to practice based workshops; and 10 to control. Electronic and manual searches yielded 450 valid and usable medical records.

Main outcome measures Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management.

Results Decision support software (P = 0.01) and practice based workshops (P = 0.01) both significantly improved rates of detection compared with control. There were no significant differences by intervention in the measures of concordance with guidelines.

Conclusions Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia.


  • Contributors MD and SI conceived the study, developed the design, obtained funding, managed the research, undertook the analysis and interpretation of findings, drafted this paper, and are guarantors. ST, JW, and MB developed and implemented the research, participated in analysis and in drafting the paper, and approved the final version. EL, JK, and RO'C contributed to design, management, implementation, interpretation of findings, and drafting of the paper and approved the final version. KH advised on statistical analysis, participated in drafting the paper, and approved the final version.

  • Funding Alzheimer's Society through the Alexander and Christina Dykes Project Grant.

  • Competing interests SI has received research funding from pharmaceutical companies producing drugs used in the treatment of Alzheimer's disease. Ethical approval: Obtained from local ethics committees.

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